Joint Custodial Agreement Information
The Joint Custodial Agreement is a written agreement between the insurance company HMO or LSHMO and IDOI for the company’s or HMO’s statutory deposit to protect the interests of the policyholders or enrollees.
The Joint Custodial Agreement is required by IC 27-1-20-8 for insurance companies, IC 27-13-13 for HMOs and IC 27-13-34-17 for LSHMOs.
Instructions
- Prepare three copies of the Joint Custodial Agreement before the signatures are affixed. Three original signatures are needed so that all parties to the agreement will have a copy for their file.
- Type or print all information on the agreements, except for the original signatures.
- On page one, fill in the Custodial Account Number, the date (the effective date of the Agreement), and the full names of the bank and insurance company as "Depositor".
Notice: Securities held for this account must be in safekeeping, not in trust. If a safekeeping area is not available in the bank chosen by the company, another bank must be selected (see item #4 in the body of the agreement). - All signatures must be original; no facsimiles.
- Upon execution of the Joint Custodial Agreements by the company and the bank, return all three agreements and one copy of attachment #1 to the address provided below. When the agreements have been executed by IDOI, we will send a copy to the company and the bank.
- Attachment #1 (information page) is intended for use by IDOI. Please provide all the information requested about the custodian bank and the insurance company.
Learn more about Joint Custodial Agreement and access the form.
If you have any questions regarding these instructions please contact:
Kathy Mathis
Telephone: (317) 232-1991
Email: kmathis@idoi.IN.gov
Once you have completed the Joint Custodial Agreement mail the forms to:
Indiana Department of Insurance
Attn: Kathleen Mathis
311 West Washington Street, Suite 300
Indianapolis, Indiana 46204-2787
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